Comparative Effectiveness of Intracranial Pressure Monitoring on 6-Month Outcomes of Critically Ill Patients With Traumatic Brain Injury
Authors: Giovanni Nattino, Lorenzo Gamberini, Obou Brissy, Greta Carrara, Randall Chesnut, Valentina Chiarini, Arturo Chieregato, Akos Csomos, Joanne M. Fleming, Primoz Gradisek, Rafael Kaps, Theodoros Kyprianou, Isaac Lazar, Stanley Lemeshow, Malgorzata Mikaszewska-Sokolewicz, Giulia Paci, Carlotta Rossi, Nancy Temkin, Nektaria Xirouchaki, Aimone Giugni, Guido Bertolini, Fulvio Agostini, Claudio Ajmone-Cat, Giovanni Bassi, Vasileios Bekos, Marzia Bellin, Maria Grazia Bocci, Valeria Bonato, Alfeo Bonato, Manuela Bonizzoli, Paola Bonucci, Andrea Bottazzi, Italo Calamai, Giuseppe Calicchio, Fabrizia Carlin, Sergio Casagli, Carlo Alberto Castioni, Rita Ciceri, Francesco Cocciolo, Ezio Crestan, Gabor Csato, Peter Cseplo, Francesco Curto, Wojciech Dąbrowski, Anna De Cristofaro, Alessandra De Luca, Izabela Duda, Or Duek, Blanka Emoke Bakó, Nazzareno Fagoni, Paola Fassini, Enrico Ferri, Suada Filekovic, Gilberto Fiore, Emiliano Gamberini, Diego Gattari, Massimo Gianni, Maria Giovanna Dessena, Romano Giuntini, Stefania Guido, Rita Gyulai, Amir Hadash, Renata Hribar, Stavroula Ilia, Vesna Novak Jankovic, Vlado Jurekovic, Mateja Jereb, Maciej Kapias, Dragica Karadzic, Darja Kasnik, Volakakis Vaggelis, Adrienn Kitti Szaszi, Janez Kompan, Eraclis Kyriakides, Silvia Lagomarsino, Sara Lamborghini, Sergio Livigni, Paolo Malacarne, Maria Martelli, Marina Alessandra Martin, Costanza Martino, Andrea Marudi, Martina Melis, Francesca Mengoli, Tomislav Mirkovic, Wiktoria Mizak, Marina Munari, Gabor Nardai, Ennio Nascimben, Giuseppe Natalini, Giancarlo Negro, Csaba Nemes, Mara Olga Bernasconi, Michele Pagani, Vieri Parrini, Panagio Partala, Mauro Pastorelli, Isabella Pellicioli, Paolo Perino Bert, Nicola Petrucci, Simone Piva, Daniele Poole, Laila Portolani, Danilo Radrizzani, Anna Rekas, Paweł Robak, Antonio Rosano, Patrizia Ruggeri, Marco Sacchi, Ágnes Sárkány, Mara Skoti, Alja Skrt, Ermanno Spagarino, Wiktor Sulkowski, Balázs Szedlák, Marina Terzitta, Rebecca Tinturini, Rossella Tofani, Paraskevi Tselioti, Ada Vecchiarelli, Elisabetta Venturini, Salvatore Visconti, Valeria Zompanti, Roberto Zoppellari
Journal: JAMA Network Open (2023)

While the relationship between persistent elevations in intracranial pressure (ICP) and poorer outcomes is well established for patients with traumatic brain injury (TBI), there is no consensus on how ICP measurements should drive treatment choices, and the effectiveness of ICP monitoring remains unknown.To evaluate the effectiveness of ICP monitoring on short- and mid-term outcomes of patients with TBI.CREACTIVE was a prospective cohort study that started in March 2014 and lasted 5 years. More than 8000 patients with TBI were enrolled at 83 intensive care units (ICUs) from 7 countries who joined the CREACTIVE Consortium. Patients with TBI who met the Brain Trauma Foundation guidelines for ICP monitoring were selected for the current analyses, which were performed from January to November 2022.Patients who underwent ICP monitoring within 2 days of injury (exposure group) were propensity score-matched to patients who were not monitored or who underwent monitoring 2 days after the injury (control group).Functional disability at 6 months as indicated by Glasgow Outcome Scale-Extended (GOS-E) score.A total of 1448 patients from 43 ICUs in Italy and Hungary were eligible for analysis. Of the patients satisfying the ICP-monitoring guidelines, 503 (34.7%) underwent ICP monitoring (median [IQR] age: 45 years [29-61 years]; 392 males [77.9%], 111 females [22.1%]) and 945 were not monitored (median [IQR] age: 66 years [48-78 years]; 656 males [69.4%], 289 females [30.6%]). After matching to balance the variables, worse 6-month recovery was observed for monitored patients compared with nonmonitored patients (death/vegetative state: 39.2% vs 40.6%; severe disability: 33.2% vs 25.4%; moderate disability: 15.7% vs 14.9%; good recovery: 11.9% vs 19.1%, respectively; P = .005). Monitored patients received medical therapies significantly more frequently.In this cohort study, ICP monitoring was associated with poorer recovery and more frequent medical interventions with their relevant adverse effects. Optimizing the value of ICP monitoring for TBI requires further investigation on monitoring indications, clinical interventions, and management protocols.